Granulomatous Spondylitis

Epidemiology

Granulomatous infection, especially tuberculous spondylitis, is a disease of children in developing countries, but occurs occasionally in adults. Debilitation, immunosuppression, alcoholism, and drug addiction are predisposing conditions. There is no gender predilection. The cervical spine is a relatively uncommon site.

Clinical Features

The onset is insidious and the course more indolent. Low-grade fever and malaise are the common systemic manifestations.

Pathology

Granulomatous infection is most commonly caused by Mycobacterium tuberculosis. Other organisms include brucella and actinomycetes. The spread of infection is hematogenous. The hallmark is mononuclear phagocytic cells, some of which fuse to form multinucleated giant cells around the lesion. The bacilli lodge in the anterior or subchondral portions of the vertebral body. The infection spreads in a subligamentous fashion to involve the adjacent vertebral body. Because the tubercle bacilli do not produce proteolytic enzymes, there is relative preservation of the disc. The transverse processes and the posterior elements are less frequently involved.

Treatment

Antituberculous drugs are prescribed for a period of 9 to 12 months. Surgical debridement and stabilization are required in cases of significant mass effect causing airway/cord compression.

Imaging